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Kidney Week

Abstract: FR-PO1154

Histopathological Findings on Biopsy Among Kidney Transplant Recipients Needing Dialysis Within 2 Weeks Post-Transplant

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Rolak, Stacey, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
  • Muth, Brenda L., University of Wisconsin, Department of Medicine, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., U of Wisconsin Hospital, Madison, Wisconsin, United States
  • Djamali, Arjang, University of Wisconsin, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin, Madison, Wisconsin, United States
  • Parajuli, Sandesh, UW Health, Madison, Wisconsin, United States
Background

The need for dialysis acutely after transplant is associated with an increased risk of graft loss. No studies have characterized post-transplant graft and mortality outcomes based on biopsy-proven causes of early need for dialysis, to our knowledge. Our study reports the incidence and outcomes of histopathological cause-specific need for dialysis within two weeks following kidney transplantation at our university.

Methods

We examined kidney transplant recipients transplanted at our center between 2000-2015 who required dialysis within the first two weeks of transplant and received a biopsy during this time. Subjects were categorized into one of five categories based on their biopsy results: acute rejection (AR), acute tubular necrosis (ATN), both acute rejection and ATN (Both), other findings including tubular injury (Other), and no findings on biopsy (None). Outcomes examined included baseline characteristics, graft failure, death-censored graft failure (DCGF), and death after biopsy.

Results

Of a total of 291 patients, 111(38.1%) had Other pathology, 86 (29.6%) had ATN, 67 (23%) had AR, 22 (7.6%) had Both, and 5 (1.7%) had None. Mean time to biopsy was 8 ± 2.83 days. Of those with a diagnosis of AR, the incidence of graft failure was 36.2 per 100 person-years within the first year post-biopsy, compared to 25.1 per 100 person-years for those with ATN, and 18.9 per 100 person-years for those with Other pathology. A similar trend was seen for DCGF within the first year (32.4 for AR, 18.1 for ATN, and 12.6 for Other pathology). AR was associated with greater risk for DCGF compared to other categories, as illustrated in the K-M curve in Figure 1.

Conclusion

AR is associated with a greater risk for graft failure and DCGF than other causes of dialysis within the first two weeks post-transplant. Identification of cause of graft failure may help inform prognostic information.

Figure 1. DCGF between study groups.